Healthcare Provider Details

I. General information

NPI: 1346653789
Provider Name (Legal Business Name): KATHERINE ANN LEITNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N WILMOT RD STE B250
TUCSON AZ
85712-4416
US

IV. Provider business mailing address

PO BOX 31235
TUCSON AZ
85751-1235
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-7840
  • Fax: 520-324-7839
Mailing address:
  • Phone: 520-324-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR74365
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54430
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: